Provider Demographics
NPI:1598201774
Name:MARQUEZ, AMY BETH (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:444 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1120
Mailing Address - Country:US
Mailing Address - Phone:440-850-1691
Mailing Address - Fax:
Practice Address - Street 1:444 N BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1120
Practice Address - Country:US
Practice Address - Phone:440-850-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150287172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker